Week 5 Flashcards
how do you palpate the liver
put one hand behind the liver and go under the rib cage looking for tenderness or pain
Acute hepatitis
can be cured, it takes a little over a year of treatment and if not treated can lead to acute liver failure
how can you tell someone is immunized vs has an acute infection
for immunization/past infection when you do a blood draw you will see antibodies. If you have an active infection you will see antigens
Acute liver failure everything you need to know
- High risk for bleeding
- Hepatoencephalopathy
- check LOC - treat with Lactulose
- can develop chronic hepatitis
what are the precautions for chronic hepatitis
standard
how do you know laculose is working
patient is poopping alot
What are the main causes of cirrhosis
alcohol and hepatitis
Everything about cirrhosis
- Transplant is the only cure
- First sign: fatigue then weight loss (r/t poor apetite b/c liver is responsible for making digestive enzymes
- give a high calorie diet low in protein and high in carbs (carbs are easy to digest and protein ->NH3 buildup)
what is different about diet for patients with cirrhosis r/t alcoholism vs hepatitis
There diets need to be high in protein b/c theyre very malnurished and dehydrated
3 signs of cirrhosis (late)
- concentrated urine (amber color) and clay colored stools b/c of billirubin
- pruritis
- Jaundice
liver assessment cultural considerations
African americans and asians NORMALLY have yellow scleras therefore checking mucous membranes would be ideal
which hepatitis is the worst and why
Hep C b/c it has no symptoms but now there is a cure its called Harvoni
Fibroscan vs Fibrosure
Scan-checking for cancer
shows degree of fibrosis
Cirrhosis teaching
- avoid acetaminophen (max 2-3Gs a day)
2. aspirin and other NSAIDS (risk for bleeding)
what happens if you as a healthcare worker stick yourself and the patient has cirrhosis
you need immunoglobulin ASAP
Pancreatitis first sign then rest of signs
All signs are caused by systemic inflammation
First you get indigestion
then swelling which leads to the release of more inflammatory mediators (interleukins, prostaglandins, histamines) causing vasodilation and increasing membrane permeability -> 3rd spacing (edema) and also can cause bronchospasm (mainly histamine)
Acute pancreatitis Etiology
- gallbladder disease (RUQ pain)
- 1 in 4 women get gallbladder disease - chronic alcohol intake
- smoking, coffee
- Hypertriglyceridemia
Physical assessment of acute pancreatitis
Piercing/sharp midline epigastric pain that radiates to the back
Acute pancreatitis safety consideration
do not give pain medication until you figure out what kind of pancreatitis it is (obstructive vs non obstructive). If they have obstructive and you give them pain medication it will mask the pain and their pancreas will rupture without anyone knowing.
CMs of acute pancreatitis
- abdominal discoloration
- Grey turners sign- blue discoloration of flanks
- Cullens sign - blue around periumbilical area
Complication of acute pancreatitis
Psuedocyst
-a sac filled with fluids, enzymes and other things
Pancreatic abscess
-Collection of pus (usually need surgery unlike cyst)
what is the gold standard diagnostic test for any GI problem
CT scan
Expected labs for acute pancreatitis
everything is up including liver enzymes and bilirubin BUT calcium decreases
what is the treatment for acute pancreatitis and what are some of the considerations
- Acute pancreatitis usually heals itself and all you need to do is manage symptoms and insulin. Therefore morphine is the drug of choice but it does mimic the s/s of acute pancreatitis b/c it causes spasm of the sphinctor of oddi (in the pancrease)
- manage the B.S
- Relax the pancreas by putting them NPO
- NG tube decompression
TPN considerations
- run electrolytes prior to making the bag
- Must be given through a central line
- PPN can be given through IV - Has high glucose
- Q4H accu checks - if Potassium is to high start them on D10W (a form of PPN)
- two RNs must sign for TPN to be given
- when removing you have to assess the length of the tubing because the tip may have fallen out and is now chillen in the blood stream
Why are PPIs given in acute pancreatitis
they reduce acid which relaxes the pancreases because acid stimulates the pancrease
what are the Colloid type solutions
Albumin and Dextran
they both have high molecular weight therefore they are hypertonic, drawing fluid into the vascular space
why are lactated ringers awesome for burn patients
theyre an isotonic solution that have a less tendancy to cause 3rd spacing but still have alot of electrolytes.
when do you give hypotonic fluids
when electrolytes like Na and K+ are high
what happens to the brain when you have hyponatremia
it swells
Hypomagnesia complications
- torsades
2. seizures
Diet for acute pancreatitis
- first NPO
2. Start with carbs only b/c easy to digest
what is the most comfortable position for aacute pancreatitis
- fetal poisition (legs flexed)
2. side lying w/ bed elevated to 45
what are carbonic anhydrase inhibitors used for
decrease pancreatic secretions
Chronic pancreatitis interventions
- No need for NPO but give high carb meals in small sizes
2. Treat Steatorrhea with bile salts to increase the absorption of DEAK and help with fat digestion
chronic pancreatitis teaching
- diet
- Antacids AC and HC
- digestive enzymes AC
Cirrhosis complications
- bleeding
- the liver is stiff therefore venous pressure goes up causing the formation of varices which can bleed. This is why we give bblockers and endoscopic banding which is where you cauterize bleeding varices - Ascities
- Paracentesis to treat (up to 5L at a time but you gotta go slow b/c fluid shift can cause severe hypotension)
- will cause low albumin therefore take daily weights
- Measure abdomin at the highest point - Hepatoencephalopathy
- Hepatorenal syndrome- high portal pressure causes spasm of renal arteries leading to renal ischemia 8i
Transjugular intrahepatic portosystemic shunt (TIPS)
shunts blood away from the liver to decrease chance of bleeding
Sengstaken Blakemore tube
Used to stop bleeding by using a balloon to cause a mechanical obstruction/pressure directly on the site of bleeding
Cirrhosis considerations
- ROM b/c these patients are bed ridden.
2. Elevate scrotum b/c it fills with fluids and can rupture.
what type of pain will a pt with cholecystitis feel
RUQ pain radiating to right shoulder
how can you stimulate micturition in clients with spastic bladder
- stroking the inner thigh
- diuretics do not work you need antispasmodics
- NOT crede maneuver which only works for flaccid bladders (direct pressure applied over the bladder to express urine)
- NOT valsalva which only works for flaccid bladder
Autonomic dysreflexia
A syndrome where you have a sudden increase in BP you should
- elevate HOB (priority)
- loosen clients clothing (body temp and tactile stimulation stimulate the reflex)
- Empty bladder and have a bowel movement (full bladder and fecal impaction triggers the reflex)
- Hydralazine
